Repro 9 - Ovarian Disorder Flashcards
Where in the ovary does Oognesis occurs?
In the follicles that are located in the cortex of the ovary.
What is the length of time that a corpus luteum have?
Around 14 days.
In the two cell theory of estrogen production, which cells does LH stimulate?
Theca cells.
In the two cell theory of estrogen production, which cells does FSH stimulate?
Granulosa cells.
What is the average age of menopause?
Around 51 years of age.
What is the definition of menopause?
1 year w/o menses.
What is premature ovarian failure?
Premature atresia of follicles before the age 40. There is a decrease of estrogen and inhibin. Increase in FSH and LH.
What would be the causes of anovulation?
First few years after menarche. Pregnancy (always do it). Endocrine (thyroid, hyperprolactinemia, Cushing, Adrenal insuf). HPO axis (Premature ovarian failure, stress, starvation, anorexia, obesity).
What are the diagnostic criteria of PCOS?
Oligo- or anovulation. Hyperandrogenism. Polycystic ovaries on Ultra Sound (a bunch of 3 to 5 mm follicles) on the periphery of the ovary “string of pearls”. You need only 2 of the 3 to make the diagnosis.
What are symptoms that can be related to PCOS?
Obesity. Insulin resistance.
What is the difference b/w Hirsutism vs Virilization?
Hirsutism: Male pattern hair growth, acne, muscle mass. Virilization: Male-pattern balding, deepening of voice, Clitoromegaly.
What is the pathophysiology of PCOS?
There is an increase in LH, increasing LH/FSH levels. The LH stimulates the theca cells to produce the androgen. However, since the FSH stays low (due to the increase in sex hormones), it cannot convert all the androgens into estrodial, causing the virilization: Anovulation results from dysregulation of hormornes.
How does insulin resistance tie in into PCOS?
Increase insulin resistance leads to increased insulin levels: Insulin stimulates androgen production in theca cells. Insulin and androgen suppress sex hormone binding globulin production.
What is the treatment for PCOS?
Weight loss. Metformin. Progesterone. Clomiphene. Leuprolide. Spironolactone.
What do we use to bring back ovulation in PCOS patients?
Clomiphene. Leuprolide (in pulsatile form). Spironolactone. Ovarian drilling.
What is the mechanism of action of Clomiphene?
Partial agonist at estrogen receptors in hypothalamus. Decreases negative feedback by estrogen, Increasing FSH.
What are the side effects of Clomiphene?
Hot flashes. GI and breast discomfort. Vision changes. Use too much and it causes ovarian hyperstimulation and enlargement, which causes pain, torsion, and may cause birth of twins.
What is the mechanism of action of Letrozole?
Aromatase inhibitor.
What is the underlying cause of PCOS?
Elevation in Luteinizing hormone.
A patient w/ PCOS is most at risk for developing which type of cancer?
Endometrial cancer.
Under what circumstances would you expect to see an elevated LH?
Normal surge before ovulation. Menopause. PCOS. Androgen insensitivity syndrome.
